More than 2,500 Missouri athletes held out of games due to concussions last year

A Tipton High School football player remains in the hospital after suffering an injury last week. For days, Chad Stover has remained in critical condition at University Hospital in Columbia.

School officials say he suffered a severe brain injury during the game. While details on his exact injury are still unclear, attention has been put on head injuries on a national level.

Recently, the National Football League agreed to pay $765 million to retired players who sued the league over head injuries.

But medical experts say the risk starts at a much younger age, with teenagers whose brains are still developing.

ABC 17's Kristie Reeter analyzed what plans high schools have in place to deal with concussions in all sports and what parents should know about the injuries.

According to data released by the Missouri State High School Activities Association (MSHSAA), there were more than 2,500 students held out of practices and games statewide because of a concussion last year.

Football, wrestling and girls basketball were the top three sports in Missouri for reported head injuries.

Because of those head injuries, athletes missed more than 3,000 days in the classroom. Even worse, those injury reports more than doubled from the previous year.

For some Missouri students, athletic scholarships may be their only chance at college and perhaps a career in sports. However, an injury during the game could prove to be a game changer in life.

Jackson Nicoli, a Hickman High School senior, suffered three concussions in the span of 18 months.

His first concussion was during a football game, followed by one in a gym class then a third during football practice.

"I have headaches, I forget things that usually most people wouldn't forget," Nicoli told Reeter.

After visiting a specialist, Nicoli decided to quit football because the risk was too great.

Concussions are caused by a direct or indirect jolt that shakes the brain inside the skull.

"In severe enough instances, it can actually hit the side of the skull and causing the injury to the brain," said Pat Forbis, the coordinator of sports medicine at St. Mary's Health Center.

He says people need to rest the idea that if you have a concussion, you have to be knocked out. Forbis says sometimes athletes can look normal after a concussion, then two-to-three hours later start showing symptoms like dizziness, headaches and sensitivity to light.

If a concussion is not caught, dire consequences can happen.

"There is a thing called the second impact syndrome," said Forbis. "What happens is the brain begins to swell. Fifty percent of those who have this injury are pretty well incapacitated mentally the rest of their life. The other 50 percent die."

He says it's suspected this happens in athletes up to the age of 19 who keep playing before a concussion has healed.

Even with the potential outcome, it has only been in the last several years that major changes to concussion protocol have happened.

In 2011, a law passed in Missouri, which requires a youth athlete suspected of having a brain injury to be removed from competition for at least 24 hours. To come back, the athlete has to be cleared by a health care provided trained in concussions.

MSHSAA helped write that law and also has additional guidelines on top of it for returning athletes to play.

"We have a protocol in place that goes over about a seven-day period of time," said MSHSAA associate executive director Harvey Richards.

Those steps included rest and light exercise. Once symptoms of a concussion are gone, the athlete can progress back into play, which could be days or weeks.

"For kids, 12 to 13 days was the earliest they got back into play," said Forbis. "Then we have some that are 100, 200 days.

In Jefferson City and Columbia schools, most athletes in contact sports are given a test usually at the start of the season to determine what their "normal" is.

After a suspected concussion, the athletes are tested again to see where they stand.

ABC 17's Reeter had Stefanie West, the certified athletic trainer at Hickman High School in Columbia, run through the test with her.

The examination includes asking the the athlete if they have any symptoms of a concussion as well as testing memory and concentration.

In Jefferson City, school officials track data on concussion among athletes looking for trends to get a better idea of what to focus on.

While this protocol may not seem thorough, not all schools have it. Also, the concussion must be caught.

"Do you think there are ever times where maybe a students does have a concussion, but they don't catch it out there and they are allowed back in the game?" Reeter asked.

"All the time," said MSHSAA's Richards. "And I don't want to say that facetiously, you know lackadaisical, but that's why we are out here trying to do this education."

Therefore, education is key. After calling more than a dozen schools in Mid-Missouri, Reeter discovered many athletic trainers are not in-house on a daily basis, like at practices where most injuries can happen.

MSHSAA says only about 25 percent of its member schools have an athletic trainer. For some schools, it's just the coach on the field helping athletes after an injury.

That is why the association requires all coaches to go through an education program on concussions each year.

Some of the rules in sports are also changing.

In football, players cannot initiate contact with an opposing players whose helmet has come completely off. And if your helmet does come off, you have to stop. Officials have also been told, 'if you see it, call it.'

"When it does occur, it's got to be called and if it's a penalty, it needs to be penalized," said Harvey.

Another person helping to get the word out about concussions is Nicoli.

Although he quit football, he helps film for the team and also speaks to classes about his experience.

"It's not worth it, you only have one brain," said Nicoli. "You can't really replace it."

MSHSAA continues to review concussion protocols each year. While schools have to follow the association's guidelines to be a member, the protocols can be different.

Some schools have plans in place that go above and beyond the requirements, with athletic trainers and baseline testing. Others are not as advanced.

Numerous athletic directors told Reeter that many times it comes down to funding.

However, like with the legislation passed in 2011, state lawmakers can set requirements for schools.

Currently, there is no talk about concussion legislation for the upcoming session.

And while Missouri is keeping track of concussions reports statewide, not every state it. That is something experts are calling for on a national level.